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Phenotypes of disease severity in a cohort of hospitalized COVID-19 patients: Results from the IMPACC study.
Ozonoff, Al; Schaenman, Joanna; Jayavelu, Naresh Doni; Milliren, Carly E; Calfee, Carolyn S; Cairns, Charles B; Kraft, Monica; Baden, Lindsey R; Shaw, Albert C; Krammer, Florian; van Bakel, Harm; Esserman, Denise A; Liu, Shanshan; Sesma, Ana Fernandez; Simon, Viviana; Hafler, David A; Montgomery, Ruth R; Kleinstein, Steven H; Levy, Ofer; Bime, Christian; Haddad, Elias K; Erle, David J; Pulendran, Bali; Nadeau, Kari C; Davis, Mark M; Hough, Catherine L; Messer, William B; Higuita, Nelson I Agudelo; Metcalf, Jordan P; Atkinson, Mark A; Brakenridge, Scott C; Corry, David; Kheradmand, Farrah; Ehrlich, Lauren I R; Melamed, Esther; McComsey, Grace A; Sekaly, Rafick; Diray-Arce, Joann; Peters, Bjoern; Augustine, Alison D; Reed, Elaine F; Altman, Matthew C; Becker, Patrice M; Rouphael, Nadine.
  • Ozonoff A; Clinical & Data Coordinating Center (CDCC); Precision Vaccines Program, Boston Children's Hospital, Boston, MA, United States.
  • Schaenman J; David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States.
  • Jayavelu ND; Benaroya Research Institute, Seattle, WA, United States.
  • Milliren CE; Clinical & Data Coordinating Center (CDCC); Precision Vaccines Program, Boston Children's Hospital, Boston, MA, United States.
  • Calfee CS; University of California San Francisco School of Medicine, San Francisco, CA, United States.
  • Cairns CB; Drexel University/Tower Health Hospital, Philadelphia, PA, United States.
  • Kraft M; University of Arizona, Tucson, AZ, United States.
  • Baden LR; Boston Clinical Site: Precision Vaccines Program, Boston Children's Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States.
  • Shaw AC; Yale School of Medicine, and Yale School of Public Health, New Haven, CT, United States.
  • Krammer F; Icahn School of Medicine at Mount Sinai, New York, NY, United States.
  • van Bakel H; Icahn School of Medicine at Mount Sinai, New York, NY, United States.
  • Esserman DA; Yale School of Medicine, and Yale School of Public Health, New Haven, CT, United States.
  • Liu S; Clinical & Data Coordinating Center (CDCC); Precision Vaccines Program, Boston Children's Hospital, Boston, MA, United States.
  • Sesma AF; Icahn School of Medicine at Mount Sinai, New York, NY, United States.
  • Simon V; Icahn School of Medicine at Mount Sinai, New York, NY, United States.
  • Hafler DA; Yale School of Medicine, and Yale School of Public Health, New Haven, CT, United States.
  • Montgomery RR; Yale School of Medicine, and Yale School of Public Health, New Haven, CT, United States.
  • Kleinstein SH; Yale School of Medicine, and Yale School of Public Health, New Haven, CT, United States.
  • Levy O; Boston Clinical Site: Precision Vaccines Program, Boston Children's Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States.
  • Bime C; University of Arizona, Tucson, AZ, United States.
  • Haddad EK; Drexel University/Tower Health Hospital, Philadelphia, PA, United States.
  • Erle DJ; University of California San Francisco School of Medicine, San Francisco, CA, United States.
  • Pulendran B; Stanford University, Palo Alto, CA, United States.
  • Nadeau KC; Stanford University, Palo Alto, CA, United States.
  • Davis MM; Stanford University, Palo Alto, CA, United States.
  • Hough CL; Oregon Health Sciences University, Portland, OR, United States.
  • Messer WB; Oregon Health Sciences University, Portland, OR, United States.
  • Higuita NIA; Oklahoma University Health Sciences Center, Oklahoma, OK, United States.
  • Metcalf JP; Oklahoma University Health Sciences Center, Oklahoma, OK, United States.
  • Atkinson MA; University of Florida, Gainesville and University of South Florida, Tampa, FL, United States.
  • Brakenridge SC; University of Florida, Gainesville and University of South Florida, Tampa, FL, United States.
  • Corry D; Baylor College of Medicine, and the Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey, Houston, TX, United States.
  • Kheradmand F; Baylor College of Medicine, and the Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey, Houston, TX, United States.
  • Ehrlich LIR; The University of Texas at Austin, Austin, TX, United States.
  • Melamed E; The University of Texas at Austin, Austin, TX, United States.
  • McComsey GA; Case Western Reserve University, Cleveland, OH, United States.
  • Sekaly R; Case Western Reserve University, Cleveland, OH, United States.
  • Diray-Arce J; Clinical & Data Coordinating Center (CDCC); Precision Vaccines Program, Boston Children's Hospital, Boston, MA, United States.
  • Peters B; La Jolla Institute for Immunology, La Jolla, CA, United States.
  • Augustine AD; National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, MD, United States.
  • Reed EF; David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States.
  • Altman MC; Benaroya Research Institute, Seattle, WA, United States.
  • Becker PM; National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, MD, United States.
  • Rouphael N; Emory University, Atlanta, GA, United States. Electronic address: nroupha@emory.edu.
EBioMedicine ; 83: 104208, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2035962
ABSTRACT

BACKGROUND:

Better understanding of the association between characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19) and outcome is needed to further improve upon patient management.

METHODS:

Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) is a prospective, observational study of 1164 patients from 20 hospitals across the United States. Disease severity was assessed using a 7-point ordinal scale based on degree of respiratory illness. Patients were prospectively surveyed for 1 year after discharge for post-acute sequalae of COVID-19 (PASC) through quarterly surveys. Demographics, comorbidities, radiographic findings, clinical laboratory values, SARS-CoV-2 PCR and serology were captured over a 28-day period. Multivariable logistic regression was performed.

FINDINGS:

The median age was 59 years (interquartile range [IQR] 20); 711 (61%) were men; overall mortality was 14%, and 228 (20%) required invasive mechanical ventilation. Unsupervised clustering of ordinal score over time revealed distinct disease course trajectories. Risk factors associated with prolonged hospitalization or death by day 28 included age ≥ 65 years (odds ratio [OR], 2.01; 95% CI 1.28-3.17), Hispanic ethnicity (OR, 1.71; 95% CI 1.13-2.57), elevated baseline creatinine (OR 2.80; 95% CI 1.63- 4.80) or troponin (OR 1.89; 95% 1.03-3.47), baseline lymphopenia (OR 2.19; 95% CI 1.61-2.97), presence of infiltrate by chest imaging (OR 3.16; 95% CI 1.96-5.10), and high SARS-CoV2 viral load (OR 1.53; 95% CI 1.17-2.00). Fatal cases had the lowest ratio of SARS-CoV-2 antibody to viral load levels compared to other trajectories over time (p=0.001). 589 survivors (51%) completed at least one survey at follow-up with 305 (52%) having at least one symptom consistent with PASC, most commonly dyspnea (56% among symptomatic patients). Female sex was the only associated risk factor for PASC.

INTERPRETATION:

Integration of PCR cycle threshold, and antibody values with demographics, comorbidities, and laboratory/radiographic findings identified risk factors for 28-day outcome severity, though only female sex was associated with PASC. Longitudinal clinical phenotyping offers important insights, and provides a framework for immunophenotyping for acute and long COVID-19.

FUNDING:

NIH.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male Language: English Journal: EBioMedicine Year: 2022 Document Type: Article Affiliation country: J.ebiom.2022.104208

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male Language: English Journal: EBioMedicine Year: 2022 Document Type: Article Affiliation country: J.ebiom.2022.104208